Revision Rhinoplasty and Ethnic Rhinoplasty
Rhinoplasty can be a life-changing procedure, but some patients are left unsatisfied with their results. Patients may be unhappy with the aesthetic outcome of their procedure, or experience breathing difficulties or other functional defects. Revision rhinoplasty is designed to correct the effects of a previous surgery, and can be far more difficult to perform than an initial rhinoplasty.
Ethnic rhinoplasty - or rhinoplasty that provides a natural-looking complement to a patient’s ethnic features - can be especially difficult to perform, which unfortunately results in a frequent need for revision procedures.
If you want or need to correct the results of a previous surgery, it is very important to seek a surgeon with vast experience in revision rhinoplasty. Furthermore, it is extremely important to find a surgeon experienced in treating patients of your ethnicity.
As with any cosmetic surgery, it pays to invest time and patience in finding the right surgeon. In fact, this is the single most important way that patients themselves can influence the success of a revision rhinoplasty procedure.
Why Revision Becomes Necessary
Rhinoplasty is one of the most difficult surgeries a plastic surgeon can perform. Unlike a procedure such as eyelid surgery, which requires a two-dimensional approach, nasal surgery is three-dimensional. Some surgeons may be hesitant to perform rhinoplasty because they simply do not enjoy it. I personally believe that choosing a surgeon who loves performing rhinoplasty can improve the likelihood of better results.
Often, surgeons fail to tell a patient “no” when he or she is not a candidate for rhinoplasty, or the desired results are unrealistic. Surgeons have a responsibility to tell patients if they think the desired results will look unnatural.
Many doctors have a poor understanding or preconceived notion of what constitutes balance. This can create odd or unnatural-looking rhinoplasty results. I think that the best way to achieve beautiful results is to try to complement the entire face, not just create an attractive nose.
Often, surgeons fail to tell a patient “no” when he or she is not a candidate for rhinoplasty, or the desired results are unrealistic. Surgeons have a responsibility to tell patients if they think the desired results will look unnatural. This is not only ethical, but also the surest way to prevent the need for costly, complex revision surgery.
Of course, unsuccessful rhinoplasty can affect more than a patient’s appearance. Breathing problems after rhinoplasty can have a significant impact on your overall health and comfort. Patients may find themselves breathing through their mouths or unable to exercise at the level that they would like. These issues can be corrected with the attention of a skilled plastic surgeon.
Ethnic Rhinoplasty Revision
Performed correctly, ethnic rhinoplasty should preserve the distinct facial characteristics of African American, Hispanic, Middle Eastern, and Asian patients. I feel that the most harmonious results respect and honor the patient’s background, while enhancing the overall balance and appearance of their facial features.
Patients of the same ethnicity often share common goals for rhinoplasty, but there is no one-size-fits-all solution. African American patients, for example, may want to move wider nostrils in, and build up the bridge of the nose. But if a small nose tip will look unnatural on a broad-featured face, the surgeon owes it to the patient to provide appropriate guidance. It is especially important to educate these patients and manage expectations accordingly. There are many surgeons who will provide the results that the patient wants to see, but if these results look obvious or strange, the patient will likely seek a revisional procedure in the future.
A thorough consultation is necessary to the success any cosmetic surgery. Revisional rhinoplasty patients should choose a doctor who spends considerable time listening to their issues and treatment goals, answering all questions, and addressing concerns. During an initial visit, you will be asked to provide a detailed medical history and information on any past rhinoplasty procedures. The doctor should meet with you personally at this first visit. Patients often wish to see what types of results they can expect, and I discourage them from trusting imaging software. Anyone can Photoshop an image to your desired specifications. Instead, you should ask to see before and after pictures of the surgeon’s actual patients. If you are undergoing ethnic rhinoplasty revision, it is obviously important to view photos of patients with a similar background. You should ask to see a wide variety of revision cases, including older and younger patients and various types of results.
Once a nurse has taken a detailed medical history of my patient, I hand him or her a mirror. First, I ask what they would like to see and what they would ideally change about their nose. Your doctor should largely let you lead this conversation. Meanwhile, it is extremely important to express specific concerns during the consultation. For example, you might wish to:
- Straighten the bridge of the nose
- Remove a bump
- Build up or narrow the bridge
- Reshape the tip of the nose
- Narrow or widen the nostrils
- Alter the angle between the nose and upper lip
Next I will perform a thorough physical examination, evaluating the inside and outside of the nose, your skin quality, nasal bones, and septum. Once the examination is complete, I will hand the patient a mirror again and explain what I can realistically help them achieve. Using a pointer to highlight areas of asymmetry and other imperfections, I will discuss my capabilities, as well as limitations.
The importance of developing realistic expectations prior to revision rhinoplasty cannot be overstated. Your doctor should thoroughly explain not only what can go right, but also what can go wrong. Additionally, ask how frequently your doctor must perform revisions of his or her own work, and why.
Preparing for Surgery
Your doctor and medical team should explain the entire process so you know what to expect before, during, and after surgery. You will be provided with detailed pre- and postoperative instructions, such as avoiding certain medications, vitamins, and birth control. Patients are often asked to complete blood tests which will require fasting. Our nurse makes sure to also recommend items you should have on hand after the procedure.
You should choose a surgeon who understands the sensitive nature of these cases, makes you feel comfortable, never rushes you, and truly listens to your goals and concerns.
Once the surgery is scheduled, I meet with my patients to review their actual treatment plan in detail. This can be the hardest appointment, particularly since patients seeking corrective procedures are often extremely hesitant to undergo surgery again. You should choose a surgeon who understands the sensitive nature of these cases, makes you feel comfortable, never rushes you, and truly listens to your goals and concerns.
On the day of your surgery, you will need to bring a friend or family member who will be able to drive you home. The effects of anesthesia will make you groggy for several hours, and it will be unsafe for you to drive.
The Revision Procedure
My patients receive light general anesthesia to keep them comfortable throughout the procedure. You will meet with the anesthesia provider who will answer any questions before you are taken to the operating room.
Unlike earlier prosthetics, which consisted of blocks of silicone, a porous material encourages your own natural tissue to restore recessed areas. These new implants are extremely safe and have low infection rates.
Most revisional rhinoplasties take two hours or slightly longer to complete. Based on your needs, your surgeon will correct existing issues to provide results that meet your goals. Unlike primary rhinoplasty, which is often performed as a closed procedure, secondary rhinoplasty may require an open technique. During open rhinoplasty, the overlying skin is reflected to expose deeper layers of tissue and allows for greater visibility of the nasal structures. It is important to understand that open rhinoplasty does have some drawbacks. Because a greater amount of blood supply is disturbed, swelling will take longer to subside. Your surgeon should work carefully to conceal any scarring along the columella, the thin strip of tissue that separates the nostrils.
Augmenting the Nose
In some cases, revisional rhinoplasty involves replacing lost tissue and cartilage. Your surgeon may choose to use your own tissue, which can be harvested from elsewhere in the septum or another area of the body, such as the ribs. Advanced synthetic grafting materials like Porex implants can offer a wealth of benefits. These synthetic implants are porous, providing a type of trellis to encourage the growth of tissue around a framework. Unlike earlier prosthetics, which consisted of blocks of silicone, a porous material encourages your own natural tissue to restore recessed areas. These new implants are extremely safe and have low infection rates. In the rare instance that the material shifts or moves, it can often be removed because the tissue has already been sufficiently regenerated.
Refining the Nose
Most revisions do not require grafts. Refinement of scar tissue is a much more common need. In some cases, too much cartilage can impact the appearance of the nose, or the scar tissue may be asymmetrical. Your surgeon might need to simply reposition what is already in place. In the case that your initial results were not as pronounced as you would have liked, the surgeon may remove more tissue - narrowing the nostrils, for example, or further reducing the bridge of the nose.
What to Expect after the Procedure
Once the effects of the anesthesia subside, you will wake up in a recovery room. You should expect to have difficulty breathing through your nose. A splint will generally be applied outside the nose with soft packing in the nostrils. I personally call my patients the evening of their procedure at home. Three to five days later, patients return to my office to have the packing removed, and your splint will be removed typically a week after surgery. You will have follow-up appointments scheduled at periodic intervals in the upcoming weeks and months. In addition to these check-ups, your doctor should schedule visits or speak with you on the phone if you have questions at any point.
Revisional procedures naturally carry a higher degree of risk than initial surgeries, and any trustworthy surgeon will support this statement. I tell my patients that there is a significant probability I can improve upon their results, but there is also a chance we will break even, or even a small chance that another procedure will make the situation worse. A greater amount of scar tissue can make it more difficult to operate. And realistically, it is difficult to plan exactly how the surgery will proceed until we can get a better look at the inside of the nose.
Revisional procedures naturally carry a higher degree of risk than initial surgeries, and any trustworthy surgeon will support this statement.
Your surgeon should be candid about your options should revision surgery fail to provide your desired results. I tell my patients that it is possible to perform another surgery, but we will need to wait at least a year until we can operate again. This is only necessary in extremely complex and rare cases.
Managing risks is as much about creating realistic expectations as choosing a reputable doctor. Most revision rhinoplasty patients feel the risk was well worth the return: a restored appearance, relieved breathing difficulties, and overall, an improved quality of life.
Revisional Rhinoplasty Cost
Many patients’ first rhinoplasty is performed for aesthetic reasons and is not covered by insurance. Revision rhinoplasty patients generally experience more breathing issues, meaning most or all of the procedure may be covered by insurance.
The surgeon’s fee for revision rhinoplasty at my practice starts at $6,000 for closed surgery, and is $7,500 for an open procedure. If you require a graft, this could cost an additional $1,000. Anesthesia typically costs between $600 and $750. Additional fees could also be higher than primary rhinoplasty since these surgeries tend to take longer to complete. Costs will vary from practice to practice, and facility fees should be considered in your total treatment cost.
When you consider the cost of your procedure, this is not a time to shop around. Instead of trying to cut costs, you should instead choose a surgeon based on his or her experience and training. Even if you end up paying more for one doctor than another, a higher level of care will minimize the risk of requiring yet another revision.
Case Study: Lee
After noticing that her nasal tip was drooping and appearing wider after a primary rhinoplasty, my patient Lee decided she wanted to improve her appearance. At first, she had trouble finding a surgeon that she felt she could connect with. I think she and I connected because I bring the ability to listen and hear what my patients want to tell me.
“I came to Dr. Newman, and I instantly felt it,” she said. “One of the things he stressed to me was, you can talk to me for as long as you need to. You can keep coming back.”
Genuine interest and concern on my part, along with the promptness of her appointment, impressed Lee. I follow each patient’s progress for a year after surgery and make sure they understand I would rather hear from them than not, even if it is something trivial.
“It’s always nerve-wracking going into any kind of surgery,” Lee said, “and I have to say that when the day came, it was completely different from the experience I had with my previous plastic surgeon.”
I always try to educate my patients so they feel confident that they are making intelligent and informed decisions, and so they know exactly what to expect every step of the way.
“He understood what I wanted and I knew that he could provide me with the result I wanted,” she said.
Case Study: Danny
Danny originally came to me with a deviated septum that was caused and exacerbated by years of playing soccer. He was unable to breathe comfortably out of his left nostril. After delaying treatment for years due to a concern over cost and insurance, he spoke with a friend who provided a referral.
“After experiencing some hesitancy with two other doctors, he made me feel so comfortable. I had no fears and no doubts,” Danny said. “Dr. Newman was genuine, down-to-earth, and humorous, and I felt good energy from the moment I walked in.”
During the surgery, I restored Danny’s ability to breathe, corrected a deviation in the bridge, and reduced a slight hump that is often seen in patients of a Mediterranean background.
“Dr. Newman didn’t push anything. He just wanted to hear my concerns and offer his opinion,” Danny said. “He cares about how his patients look, and understands they might have an image in their mind but that it won’t look natural with the sculpture of their face.”
Danny was ecstatic about his results, and also impressed with how short his recovery was and how little bruising he experienced.
“I trusted Dr. Newman completely,” Danny said. “Everyone on the staff did a fantastic job.”
Restore Your Comfort and Appearance with Revision Rhinoplasty
With adequate research and preparation, revision rhinoplasty and ethnic rhinoplasty revision can be safe and effective ways to correct the results of a past procedure. These procedures can be difficult even for highly experienced surgeons, so take your time to thoroughly research a number of care providers before you make your choice. Meanwhile, remember: a good surgeon will not only possess advanced training and skill, but also make you feel like an individual with valuable opinions and concerns.
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